Haw. Code R. § 17-1737-79

Current through November, 2024

Section 17-1737-79 - Physical therapy and occupational therapy services

(a) Physical therapy means services prescribed by a physician that are provided to a recipient by a qualified physical therapist licensed by the state and certified by the medicaid program to provide services. Necessary supplies and equipment shall be included as part of this service.

(b) Occupational therapy means services prescribed by a physician provided to a recipient by a qualified occupational therapist who has been certified by the American Occupational Therapy Association and approved by the medicaid program to provide services. Necessary supplies and equipment shall be included as part of the service.

(c) Physical and occupational therapy may be prescribed by a physician when medically necessary and when the following conditions are met:

(1) The services are considered under accepted standards of medical practice, to be a specific and effective treatment for the patient's condition;

(2) The services or patient's condition is of a level of complexity requiring services that can be safely and effectively performed only by a qualified therapist. Maintenance therapy which does not require the performance and supervision of a therapist shall be considered as nursing rather than therapy services for separate billing, even if performed or supervised by a therapist;

(3) There is an expectation that the patient's condition will improve significantly in a reasonable period of time based on the assessment made by the physician of the patient's restoration potential, or the services are necessary to establish a safe and effective maintenance program required in connection with a specific disease state; and

(4) The amount, frequency, and duration of services are reasonable.

(d) When physical therapy or occupational therapy is requested for an acute symptomatic condition without demonstrable musculoskeletal abnormality, the therapy shall be provided for only a short period of time not to exceed two weeks, except when extended by prior approval.

(e) Where a neuro-musculoskeletal abnormality is demonstrated, a definitive diagnosis shall be made utilizing radiologic or appropriate diagnostic procedures, and if necessary, specialty consultation.

(f) All recommended therapy for non-institutional recipients shall require the approval of the medical consultant and the request shall include the following information:

(1) Diagnosis;

(2) Recommended therapy indicating the frequency and estimated duration of therapy; and

(3) For chronic cases, long term goals and a plan of care.

(g) Outpatient physical therapy services and outpatient occupational therapy shall be limited to no more than three-fourths of an hour or three modalities of treatment per day although several treatment modalities may be provided during this treatment period. Physical therapy services exceeding three-fourths of an hour or three modalities shall be specifically approved by the department prior to the provision of services.

Haw. Code R. § 17-1737-79

[Eff 08/01/94] (Auth: HRS § 346-14) (Imp: 42 C.F.R. §§440.10, 440.230 )